The impact of Medicaid expansion on trauma-related emergency department utilization: A national evaluation of policy implications.
J Trauma Acute Care Surg
; 88(1): 59-69, 2020 01.
Article
em En
| MEDLINE
| ID: mdl-31524835
ABSTRACT
BACKGROUND:
The impact of the 2014 Affordable Care Act (ACA) upon national trauma-related emergency department (ED) utilization is unknown. We assessed ACA-related changes in ED use and payer mix, hypothesizing that post-ACA ED visits would decline and Medicaid coverage would increase disproportionately in regions of widespread policy adoption.METHODS:
We queried the National Emergency Department Sample (NEDS) for those with a primary trauma diagnosis, aged 18 to 64. Comparing pre-ACA (2012) to post-ACA (10/2014 to 09/2015), primary outcomes were change in ED visits and payer status; secondary outcomes were change in costs, discharge disposition and inpatient length of stay. Univariate and multivariate analyses were performed, including difference-in-differences analyses. We compared changes in ED trauma visits by payer in the West (91% in a Medicaid expansion state) versus the South (12%).RESULTS:
Among 21.2 million trauma-related ED visits, there was a 13.3% decrease post-ACA. Overall, there was a 7.2% decrease in uninsured ED visits (25.5% vs. 18.3%, p < 0.001) and a 6.6% increase in Medicaid coverage (17.6% vs. 24.2%, p < 0.001). Trauma patients had 40% increased odds of having Medicaid post-ACA (vs. pre-ACA aOR 1.40, p < 0.001). Patients in the West had 31% greater odds of having Medicaid (vs. South aOR 1.31, p < 0.001). The post-ACA increase in Medicaid was greater in the West (vs. South aOR 1.60, p < 0.001). Post-ACA, inpatients were more likely to have Medicaid (vs. ED discharge aOR 1.20, p < 0.001) and there was a 25% increase in inpatient discharge to rehabilitation (aOR 1.24, p < 0.001).CONCLUSION:
Post-ACA, there was a significant increase in insured trauma patients and a decrease in injury-related ED visits, possibly resulting from access to other outpatient services. Ensuring sustainability of expanded coverage will benefit injured patients and trauma systems. LEVEL OF EVIDENCE Economic, level III.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ferimentos e Lesões
/
Aceitação pelo Paciente de Cuidados de Saúde
/
Medicaid
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Serviço Hospitalar de Emergência
/
Patient Protection and Affordable Care Act
Tipo de estudo:
Evaluation_studies
Limite:
Adolescent
/
Adult
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Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article